İntraabdominal Basınç Göstergesi Olarak Vena Kava İnferior Çapının Ultrasonografi ile Değerlendirilmesi

Abstract

Amaç: İntraabdominal hipertansiyon (IAH) ve abdominal kompartıman sendromu (ACS) anlamlı morbidite ve mortalite nedenleri arasında kabul edilmektedir. Bu çalışmanın amacı IAH, ACS ve abdominal perfüzyon basıncı (APP) değerlendirilmesinin non-invaziv bir teknik olarak ultrasonografi (US) ile yapılabilirliğinin araştırılmasıdır. Gereç ve Yöntemler: Çalışmaya acil servise başvuran ve yoğun bakım ihtiyacı olan mesane sondası takılan 95 hasta dahil edildi. İlk muayenede mesane içi basınç ölçümü yöntemi ile intraabdominal basınçları (IAP) ölçüldü. Vena kava inferior (VCI) çapı, pulsed wave (PW) ve santral venöz basınç (CVP) değerleri US ile kaydedildi. Hastalar IAP değerlerine göre 3 gruba (İAB <12 mm Hg, İAB =12-20 mm Hg, İAB >20 mm Hg) ayrıldı. Her grup kendi içinde VCI inspiryum (i) çapı ve VCI ekspiryum (e) çapı ile ayrı ayrı değerlendirildi. Bulgular: Hastaların yaş ortalaması 68,6±14,5 (aralık, 24-91) yıl idi. Hastaların ortanca IAP değerleri 9,55 mm Hg olarak saptanırken APP ortalaması 70,41±17,67 mm Hg idi. IAP'si normal (<12 mm Hg) olan Grup 1 ile diğer gruplar arasında VCIi ve VCIe çapları açısından istatistiksel anlamlı fark saptandı (p<0,001). Tüm hastalarda, VCI çapı ile CVP arasındaki korelasyon anlamlı bulundu (p<0,001). Sonuç: Bu çalışmada, IAP varlığı ile hem VCIi ve VCIe çapları arasında, hem de CVP değerleri arasında anlamlı bir korelasyon saptanmıştır. Yüksek VCI çap ve CVP değerlerinin değerlendirilerek IAP’ın non-invaziv yöntemlerle tanınmasının erken tanı ve tedavi imkanı sağlayarak morbidite ve mortaliteyi azaltmada etkili olabileceğini düşünmekteyiz.

Keywords

• vena kava inferior
• intraabdominal basınç
• abdominal kompartıman sendromu
• intraabdominal hipertansiyon

The Ultrasonographic Evaluation of Vena Cava Inferior Diameter as an Intraabdominal Pressure Indicator

Abstract

Aim: Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are accepted as a significant cause of morbidity and mortality. The aim of this study is to investigate the utility of ultrasonography (US) as a non-invasive technique for evaluation of IAH, ACS and abdominal perfusion pressure (APP). Material and Methods: Ninety-five patients with intensive care unit requirement, who applied to emergency department and also received a urine catheter were included in the study. During first evaluation intraabdominal pressure (IAP) calculated via measuring intravesical pressure. Inferior vena cava (VCI) diameter, pulsed wave (PW) and central venous pressure (CVP) were recorded by using US. Patients were divided into three groups according to their IAP (IAP <12 mm Hg, IAP =12-20 mm Hg, IAP >20 mm Hg). Each group were evaluated separately in terms of VCI inspirium (i) and expirium (e) diameters. Results: Mean age of the patients was 68.6±14.5 (range, 24-91) years. Median IAP was 9.55 mm Hg and mean APP was 70.41±17.67 mm Hg. VCIi and VCIe diameters were significantly different in Group 1 with normal (<12 mm Hg) IAP (p<0.001). Correlation between VCI diameter and CVP among all patients were significant (p<0.001). Conclusion: A significant correlation between both VCIi and VCIe diameters, and CVP values in case of IAH presence was found in this study. We think that, recognition of IAP with non-invasive methods via evaluating high values of VCI diameter and CVP is effective for reducing morbidity and mortality providing early diagnosis and treatment.

Keywords

• vena cava inferior
• intraabdominal pressure
• abdominal compartment syndrome
• intraabdominal hypertension

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